Around 3,000 Americans each year receive life-changing news from their doctor. They learn a cancer called “mesothelioma” grows inside their body, and it grows fast. This news usually leaves them with more questions than answers about what to do next.
This description may apply to you, and it’s understandable if it does. If you recently learned you have mesothelioma, you’ll have all sorts of questions about where to go from here.
Some of those questions are about medical options, such as surgery. It’s always one of the first topics because surgery is one of the most effective ways to treat mesothelioma.
Our medical team communicates regularly with people affected by mesothelioma, whether the patients themselves or the loved ones of patients. The victims of this cancer are conducting research and trying to answer these difficult questions before making any consequential decisions.
Our experts usually field a variety of questions about surgery, but we hear a few more frequently than others. Our goal is to empower mesothelioma patients with the most up-to-date information regarding their medical options. That’s why we’ve compiled eight of the top questions we hear concerning surgery for mesothelioma.
Are There Different Types of Surgery for Mesothelioma?
Yes, there are. The two main types of mesothelioma have different surgeries to remove the tumors from the body.
Pleural mesothelioma has two surgeries: pleurectomy with decortication (P/D) and extrapleural pneumonectomy (EPP). Peritoneal mesothelioma patients undergo cytoreduction combined with heated intraperitoneal chemotherapy (HIPEC).
These surgeries are distinctly different from one another.
How Are They Different?
Aside from their applications to different mesothelioma types, these three surgeries also involve removing different areas of the body:
- EPP for pleural mesothelioma removes the fluid-filled lining where pleural mesothelioma forms (the pleura), plus the diaphragm, nearby lung, and lining around the heart (pericardium).
- P/D surgery spares the lung and only guarantees removing the pleura. An “extended P/D” may involve taking out the diaphragm and pericardium.
- Cytoreduction with HIPEC involves removing the lining where peritoneal mesothelioma forms (the peritoneum) and meticulously locating and resecting individual tumors scattered throughout the abdominal cavity.
What Is the Effect on My Survival Chances?
Not every person with mesothelioma is a surgical candidate. You should get diagnosed and meet with a specialist to learn if your disease can be safely removed.
Additionally, some people are better suited for one surgery and not another. If you have pleural mesothelioma, the operation that’s best for you will depend on several factors, including the stage of your mesothelioma, age, and history of health issues.
So your individual survival odds after each surgery can’t be estimated without knowing more specifics about your cancer.
However, we can give data across all mesothelioma patients who underwent surgery. This information provides a best-case scenario to look forward to if you have a specific surgery in mind:
- Median survival after EPP ranges from 15-19 months, with some patients living as long as five years.
- P/D has a median survival ranging from 23-32 months, with a good portion of patients achieving long-term survival.
- Cytoreduction with HIPEC meets extraordinary survival results, with some studies reporting medians of approximately 40 months.
How Long Does Each Surgery Take?
Before we answer this, please remember that each case of mesothelioma is different. The amount of time required to remove one person’s pleura, or remove their lung, could take longer than for another person.
With that context in mind, here are the estimated times for each of the three curative surgeries for mesothelioma:
- EPP lasts around two hours.
- P/D requires 2-4 hours, with variances depending on how many areas are being removed.
- Cytoreduction with HIPEC takes 8-14 hours.
How Long Is the Recovery Time After Each Surgery?
Again, we must clarify that there’s no absolute answer to this question. Each person’s body will respond differently to aggressive surgery. However, cancer centers provide an estimated recovery time to guide patients towards a decision.
The recovery time for each surgery is below:
- EPP may require patients to remain in the hospital for a few days, and outpatient recovery usually takes 6-8 weeks. Since your lung is removed, recovery may require rehabilitating your respiratory system through physical therapy.
- P/D may require a week of in-hospital recovery and 2-4 weeks of outpatient rehabilitation.
- Cytoreduction is an intense procedure, usually requiring two weeks of inpatient recovery plus another month or two before full recovery is accomplished.
Will I Need to Undergo Further Surgeries or Tests?
You’ll almost certainly need to undergo tests following surgery. Mesothelioma has a high recurrence rate, which means the cancer returns after surgery. So regular testing and appointments help monitor your health.
In most cases, you’ll have a follow-up appointment with your specialist a week or two after the operation. Lab work and scans occur regularly, every six months to a year. If any abnormalities or signs of recurrence show up, you may need to undergo a biopsy.
If the cancer has returned, you may undergo a second minor surgery just to remove fluid or resect visible tumors. You can’t get your second lung removed, and other resectable areas were likely taken out previously, so there are limitations in a second operation.
What if I Can’t Have Aggressive Surgery? Do I Have Any Options?
Yes, there are other treatment options, such as chemotherapy and radiation. Not all patients are surgical candidates, either due to the disease’s spread or the person’s overall health. Chemotherapy and radiation can slow the cancer’s growth or even stop it from overtaking your organs.
There also are pain-relief surgeries for each type of mesothelioma. These operations involve removing fluid that has built up due to the tumors. These surgeries are:
- Thoracentesis (pleural mesothelioma)
- Paracentesis (peritoneal mesothelioma)
Pleurodesis (pleural mesothelioma) goes one step further and closes the pleural cavity where the fluid builds up. Closing this space involves sticking together the two cellular layers.
Is There Anything More I Should Know About Surgery for Mesothelioma?
There’s a lot more information you should know about each surgery. Your nutrition, exercise regimen and overall lifestyle are critical when preparing for surgery. Healthier people naturally handle surgery and surgical recovery well.
Patients often lose fluid during surgery, which means they’ll drop in weight, strength and nutrients. A high-calorie, high-protein diet will help offset these effects. We recommend eating protein-rich foods, such as:
- Cottage cheese
For vegetarians, the mesothelioma diet should shift to soy milk, tofu, almonds, walnuts and peanut butter.
If you want to know more about mesothelioma surgery, reach out to our medical experts. Jenna Campagna, one of our patient advocates, is a registered nurse who speaks with mesothelioma patients regularly. She can talk with you about surgery and even help you find a surgeon close to where you live.
Please email Jenna at firstname.lastname@example.org if you’d like her assistance.
Sources & Author
- Extrapleural Pneumonectomy. University of California San Francisco Department of Surgery. Retrieved from: https://surgery.ucsf.edu/conditions–procedures/extrapleural-pneumonectomy.aspx. Accessed: 05/15/19.
- HIPEC Surgery – What to Expect. Tufts Medical Center. Retrieved from: https://www.tuftsmedicalcenter.org/patient-care-services/Departments-and-Services/Cancer-Center/Clinical-Care-Services/Peritoneal-Surface-Malignancy-Program/What-to-Expect-After-HIPEC-Surgery. Accessed: 05/15/19.
Sources & Author